Tallywhacker Assessment 101

Yesterday was a good, but busy day in the E.R. I had the good fortune of taking care of Mr.R most of the day. Obese, with a chronic muscle disease that left him unable to change position and clear his secretions, he was with us for a new diagnosis of no surprise........pnuemonia. I got the impression he was a somewhat wealthy man by the way he spoke of his ranch, his horses and the around the clock home health assistance he had been able to finance at his own home for the past ten years.

He was pleasant and had a smile whenever I went by his room. Because we were not overly busy for the first half of the day, I had time to provide good nursing care. I (with help of course) had time to turn him almost every hour and a half, to encourage coughing and deep breathing and attempt to suction some of the secretions he was almost clearing. Heck, I even had time to wade through the 5 pages of admissions orders and home meds, figure them out and give him his meds on time. All things which are virtually unheard of when you have multiple tele hold patients in the E.R. He still has use of his arms, so basic tasks such as using the urinal and feeding himself were done by him. On top of all that, I even charted in the computer....a big deal for us one sheet driven E.R. nurses.

I was feeling very proud of myself....the epitome of good, strong, basic nursing care. And all of this was done in the E.R. Did I mention that ?

Towards the end of the shift, just as I had finally received a bed assignment, his home health aide came to visit. He introduced the two of us, said she was trained as a surgical technician, but had been his home health aide for years. I thanked him for a most excellent day in the E.R....for being so patient, so kind and so upbeat in the face of a lot of adversity and walked off to call report.

As I was just walking away, the home health aide looks at me and says under her breath "did you look at his tallywhacker ?" Umm, no. Cough, cough. Did she just say that ? "Excuse me ? What did you say ? She looked at Mr.R and said loudly "you need to show her your tallywhacker. It is swolled."

So I assessed his "tallywhacker." Indeed it was swollen, and it did require a call in to his MD and was worthy of mentioning to the nurse as I called report. According to the patient it had "just happened" and he thought it was because he had waited too long before using the urinal.

I looked and looked on the computer assessment form and there was no "tallywhacker" assessment criteria. Off to do some googling.